High-risk cardiac surgery: Time to explore a new paradigm

Figures

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  The Impella 5.5 device shown in its transvalvular position.

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  Figure 1. Transaxillary insertion of the Impella 5.5 device. After anastomosis of a 10-mm vascular graft to the axillary artery, fluoroscopy-guided advancement of the pump through an introducer and over a wire is undertaken. The inlet rests 5 cm below the aortic annulus. The short course of the device (unlike that of femorally based Impella devices) and superior fixation enhance positional stability and reduce catheter migration and hemolysis. The integral optical sensor provides real-time position status. Reproduced with permission from Abiomed Inc.

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  Figure 2. Impella 5.5 components. The catheter length is 70 cm with a cannula diameter of 21F, a motor diameter of 18F, and, unlike prior device iterations, no pigtail resides in the LV cavity. The lumen of the catheter shaft contains a purge lumen, a stainless-steel coil, a fiber-optic cable, and an electrical cable. A heparin-based purge solution is delivered constantly into the device lumen. Reproduced with permission from Abiomed Inc.

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  Figure 3. Impella 5.5 in its transvalvular position. Reproduced with permission from Abiomed Inc.

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  Figure 4. Echocardiographic midesophageal long-axis view depicting optimal placement of the Impella 5.5 within the LV cavity. The tip of the pump should be 5 cm below the aortic annuls without impinging on the mitral subvalvular apparatus or the intraventricular septum. Reproduced with permission from Abiomed Inc.

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  Figure 5. In addition to displaying placement and motor current signals (not shown), the Impella Controller screen provides continuous waveforms displaying mean aortic pressure, LV end-diastolic pressure, pump flow, and native and total cardiac outputs. Reproduced with permission from Abiomed Inc.